Acute effects of acetazolamide on cerbral blood flow in man

We have followed the time course of the effect of the carbonic anhydrase inhibitor acetazolamide injected i. v. in unanesthetized healthy human beings. The dose administered was 500 mg as a bolus. Cerebral blood flow (CBF) was measured continuously before, during and after the injection, using a pulsed ultrasound doppler system, which measured the instantaneous mean velocity across the lumen of the internal carotid artery, just below its entrance into the skull. Ventilation, heart-rate, end-expiratory PCO₂- arterial PCO₂, pH and systemic blood pressure was also measured. We found that acetazolamide caused a rise in CBF which could be detected as early as 2 min after the injection. A maximal average response of 75% increase in CBF was seen after 25 min. The half-time of the declining phase of the response was 95 min. There were no systematic differences in the CO₂ reactivities, given as ACBF/ΔPACO₂ in % of CBF at normocapnia, before and after acetazolamide injection, regardless of the absolute PACO₂ level. The present dose of the drug caused no change in ventilation, alveolar and arterial PCO₂ or in arterial blood pH indicating that the carbonic anhydrase was not fully inhibited. Our observations show that acetazolamide nevertheless caused a rapid vasodilation in the brain and over a wide range of PCO₂′s. We suggest that this agent has a local vasodilator effect on the cerebral arterioles, unrelated to its specific effects as a carbonic anhydrase inhibitor.     

Acute disseminated Aspergillosis in a cow with special reference to penetration and spread

Acute disseminated aspergillosis caused by Aspergillus fumigatus is reported in a 4-year-old cow given broad spectrum antibiotics and anti-inflammatory therapy. All stomach compartments were infected and hyphal invasion of gastric blood vessels was the probable source of generalization to the liver, lung and kidneys. Throughout the Peyer's patches of the jejunum there were acute necrotic foci with Aspergillus hyphae and similar foci occurred in the corresponding mesenteric lymph nodes. This points to the Peyer's patches being a portal of entry for A. fumigatus to the lymphatic system of the intestine.     

Helminth functional antigens (with special reference to S. mansoni)

Study of helminth antigens with a special reference to Schistosoma are reviewed, not exhaustively but rather as an overview of trends. These antigens are considered at four levels. Firstly, characterization and utilization of genus, species or stage-specific antigens should improve the efficiency of immunological diagnosis of helminth diseases. Then, some well-characterized antigens are of interest because of their involvement in the modulation of the immune response or in the immunopathological field. Finally, identification of relevant antigens capable of eliciting a protective immune response is a prerequisite to any attempt at immunoprophylaxy of helminthic infections.     

Supra-vaginal uterine amputation vs. abdominal hysterectomy: The effects on urinary symptoms with special reference to pollakisuria, nocturia and dysuria

Post-operative symptoms of hysterectomy have received relatively little attention in the literature. In the present study the first author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 patients with supravaginal uterine amputation pre-operatively and thrice post-operatively. At one year the follow-up percentage was 99.5 (211/212). In the statistical analysis McNemar's test of symmetry and Fisher's exact test were used. Loglinear models were developed where applicable.

A number of patients had urinary symptoms pre-operatively: 27.6% of the abdominal hysterectomy and 48.6% of the supra-vaginal amputation patients suffered from pollakisuria; preoperative nocturia and dysuria were present in about 10% of patients in each group. These urinary symptoms disappeared more frequently in patients who underwent supra-vaginal amputation; with regard to pollakisuria the difference is statistically significant. Twelve months post-operatively pollakisuria was present in 10.3% of supra-vaginal amputation and 13.5% of hysterectomy patients.

The advantage of supra-vaginal amputation over abdominal hysterectomy with regard to these symptoms may result from the considerably less extensive manipulation of the bladder during supravaginal amputation. Possibly the support provided by the remaining stump and the round ligaments fixed to it also help to reduce urinary symptoms in these patients. However, further urodynamic studies are needed.     

Conservative treatment of urinary incontinence in women with special reference to the use of oestrogens

Urinary incontinence was treated conservatively in 100 patients. The follow-up period was 12–24 mth. For post-menopausal women, the oestrogen therapy consisted of oral oestradiol valerate or vaginal oestrone sulphate combined with emepronium bromide. In post-menopausal patients the best results were noted when incontinence had begun at the menopause and when the duration of the complaint was not more than 3 yr. For pre-menopausal patients, the treatment given was generally emepronium bromide. During the follow-up period 15 of the patients, 11 of whom were post-menopausal, became symptomless and 77 improved; that is, the incontinence was only slight and occasional. The treatment was without any effect in 8 of the patients.

Oestrogen therapy was successful in most post-menopausal women. In these patients, the best results were obtained when the duration of the incontinence was not more than 3 yr.     

Acute natural death in adults with special reference to the under-50 age group

The cases of acute natural death of persons in the age group below 50 years were analysed in relation to the whole number of autopsies performed in the district of Leipzig (German Democratic Republic) in 1980. From a total of 137 cases, 103 (75.2%) were males and 34 (24.8%) females. The incidence per 100,000 inhabitants was 14.8 in males and 4.9 in females. The most common cause of death in the male group was the chronic ischemic heart disease ( CIHD ) with its complications. In females the noncoronarogenic death dominated. In contrast to other publications, we found only few thromboses (11%). Especially high was the number of embolia of the lung and the frequency of ruptured cerebral aneurysms in females. Of special interest are high physical activity in sports in combination with CIHD , anomalies of the coronary arteries, and hypertrophic cardiomyopathy which often causes sudden unexpected death. The results are discussed and other rare causes of acute death summarized. It seems from the literature also important to investigate histologically the heart muscle in all cases of unknown causes of acute death.